Mental Healthcare Benefits Under the Affordable Care Act

With the imminent arrival of the already-much-loathed DSM 5 and my thoughts more frequently turning to moving back to the US (I currently live in The Netherlands), I’ve been thinking a lot about what a move would/will mean for my mental healthcare.

By the time I return, the Affordable Care Act (AKA ‘ObamaCare’) will have gone live.  I never paid much attention to the finer points.  I will probably never have to opt in, but would still like to be educated about the peaks and pitfalls. In the last

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

two weeks there has been a spate of articles on the topic in mental-health-related publications, so now is as good a time as any to get the skinny.   A lot of noise is (again) being made in the right-wing media on the subject.  Since the GOP BS Machine has been known to spout incorrect rhetoric, I wanted my own answers.

For starters, I went directly to The White House.  Well, the blog, anyway.  There I found an entry by Kathleen Sebelius, the US Secretary of Health and Human Services, that was cross-posted from the HHS (Health and Human Services) blog.  While the majority of the April 10, 2013 entry talks to gun violence prevention, there is a paragraph that addresses the Affordable Care Act and mental illness coverage:

The President’s [2014] budget builds on the historic advances we have made to close the gaps that left too many Americans with behavioral health problems uninsured and underinsured. Beginning in 2014, the Affordable Care Act will provide access to quality health care that includes coverage for mental health and substance use disorder services. All new small group and individual private market plans will be required to cover mental health and substance use disorder services as part of the health care law’s Essential Health Benefits categories, and behavioral health benefits will be covered at parity with medical and surgical benefits. Also in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing behavioral health condition. The Affordable Care Act has already ensured that new health plans cover recommended preventive benefits without cost sharing, including depression screening for adults and adolescents and behavioral assessments for children.

Underline is mine, and a point that had nagged at me.  Both the GOP and some psychiatric publications have stated that under the Affordable Care Act, mental healthcare would not be covered by the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  They are wrong.  Thankfully.

As I continued to read, I delved further into more views of those in the crazy-biz.  Three themes kept emerging:

• Under the Affordable Care Act, mental health benefits will differ state to state.
• The American Psychiatric Association has already written a letter to The Department of Health and Human Services over concerns that states would judge network adequacy for psychiatrists included in QHP [qualified health plans] networks on the basis of the number of psychiatrists in a network, as opposed to the number of days it takes for a patient to get an appointment with a psychiatrist.”
• If your doc prescribes a drug that is not in ‘the formulary,’ patients are certainly free to file an appeal (much the way most insurance companies demand today) so it will be covered. “The HHS declined to order formularies in QHPs to adhere to the Medicare Part D requirement that all drugs in 6 “protected” categories be available. Those 6 include antidepressants and antipsychotics.”

Combine the info from the first and third bullet points, and the sum is that one state may offer access to 250 ‘covered’ drugs while another could offer over 700.

It is worth noting that those three points above are being broadcast by a constituency that has a lot of skin in the game.   And, nothing above is surprising, really.  Typical red tape you’d expect to come across when dealing with any insurance plan.  So, it’s understandable why mental healthcare workers aren’t enchanted with these things.

To be fair, I did visit a few right-wing/I Hate ObamaCare news sites and blogs as well.  While I was looking for info specifically related to opinions on the Affordable Care Act as it pertains to mental illness coverage, there was a pervasive undercurrent of a lack of understanding of how the US Federal Government works in general.  I state this not for any partisan reason, but to call out that I am suspect of the information I was able to uncover.  Basically, the takeaway from those sites I visited is that expanded mental health coverage under the Affordable Care Act will put a serious strain on mental healthcare providers, due to the approximately 60 million new patients who will become eligible for mental health treatment.  The CEO of behavioral health services for the Henry Ford Health System stated that the influx of new patients from the health law would strain the nation’s mental health workforce. “We now worry that we [will] have the providers and the delivery system to take care of them,”  I could find no mention of how those opposed to the Affordable Care Act would remedy this particular problem.

Finally, I visited NAMI (National Alliance on Mental Illness).  They provide a very useful FAQ and downloads to help those with mental illness navigate the coming changes the Affordable Care Act will bring.  One item I am particularly happy to see is a Policy Maker’s Toolkit.  For the laypeople among us, it’s a small glimpse into the considerations that need to be made when making mental health policy decisions.

Bottom line:   I was expecting to find at least some controversial ‘stuff’ when researching this topic.  Truthfully, I found nothing I didn’t already expect.  The worst thing that I can see from the amount of research I had the time to do is the Affordable Care Act does not set a nationwide, uniform standard for determining what kind of coverage benefits each level should include. That decision will be left to the states, a point of concern to some healthcare-advocacy groups.  Quite frankly, it is a concern of mine as well.

In the end, let’s not forget this is a fledgeling program, and like the 787, it’s going to need to work out the kinks so it can truly fly.  From a personal perspective, I am happy 60+ million Americans will finally have access to mental healthcare.

It’s about time.

Psychiatric ‘Patient Dumping’

Oh, how poorly we Americans treat our mentally ill.

http://abcnews.go.com/Health/man-psychosis-recalls-nevada-patient-dumping/story?id=19095175

James Brown, who has been diagnosed with psychosis, spent three days at Rawson-Neal Psychiatric Hospital, in Las Vegas, in February 2013. Depressed and thinking of suicide, Brown ended up there after problems at his group home.

But just three days after he was admitted, the doctors felt James was stable enough to go.

Then, Brown says the doctor asked him what state he wanted to go to.

“I said, ‘I don’t want to leave Nevada,’” Brown told ABC News. “He said, ‘California sounds like a really nice state. I think you’ll be happy there.’”

Although Brown had never been to Sacramento, he says he was told he would get better mental health care there. Brown was driven to a Greyhound bus station with a $306 one-way bus ticket, six Ensure nutrition shake bottles and just a three-day supply of psychiatric medications.

Brown’s discharge papers even listed his “address on discharge” as “Greyhound Bus Station to California.”

 

You’d never see Catherine Zeta-Jones treated this way.

This is nothing less than human trafficking.

Deplorable.

Evil Brains – What Lurks Inside a Killer’s Mind

Don’t let the misleading title of the article fool you.

Mental illness and brain abnormalities are once again being described/equated with evil.

Sigh.

http://science.time.com/2013/05/03/evil-brain/

Depressive Thinking Can Be Contageous

 

Researchers studying a group of college students found that certain types of depressive thinking can spread from close-living roommates like a lingering flu.

 

Although many people see depression as a chemical imbalance in the brain, scientists say social context and the way you see yourself and the world can be critical in causing and sustaining the illness, which affects around 10% of college-age adults.

 

Although this study was conducted with, “…108 incoming college freshmen at a private university in the Midwest, including 42 men with male roommates and 66 women with female roommates randomly assigned by the college,” I’ve seen this dynamic in action in a workplace that was comprised of adults, mostly over the age of 50, all threatened with an imminent, massive lay-off.  The article cites the Rumination prone personality type as being the more contagious rather than the Hopelessness brand, but I’ll argue any day that both are just as viral.

Read more at: http://healthland.time.com/2013/04/24/depressive-thinking-can-be-infectious/#ixzz2RTgdaLst

My Doctor is a Hoser

Cover of Strange Brew

I’m sure all of you Strange Brew fans know exactly what I’m talking about.  Yeah, my doctor is a Hoser.  Or, it’s actually my psychiatrist intern who is on the line.

Today was my first face-to-face with her after being released from the bin.  I knew she was going to be extremely nice and polite during our appointment.  During my last appointment with my NP, I had the distinct impression The Hoser was in big trouble for letting me get to a state where I had to be admitted.  Especially after my NP asked me in a very direct manner how I felt treatment with The Hoser was progressing and if I had any complaints.

Long story short – a 30 minute appointment turned into 45 because she tried to make coffee for herself twice but got completely sidetracked by the coffee pad for the Senseo, the ‘bloody’ computer system is so confusing she can’t figure out how many refills of what I have left, flipping through her agenda (twice!) for our next appointment resulted in the discovery this is April and not May, and we spent a full five minutes where she asked me how she should go about following up with my treatment.  (No, really.  What should I do??)

Maybe this is really 3B Treatment – three beers and it looks good.

So, yeah.  Today was almost a cluster.  Except for one thing.  The best part was when the appointment was over and I was walking down the hall, away from the mental health wing to the main hospital.  That’s when I decided she is a Hoser.  And I had to bite my tong very hard to keep from laughing out loud.  A woman walking away from the Looney Wing, laughing to herself, is never seen as OK.  And that last thought made me want to laugh even harder.

Hey, you gotta take those laughs wherever you can get ‘em, eh?

A Sleeping Pill Without The Sleepy Head?

[I'll be taking a week+ hiatus - for a real vacation this time!  Thank you in advance for your comments...I'll catch up when I return.]

Time Health & Family ran an interesting piece this week.  It seems researchers have developed a new class of sleeping medication that, in rats and rhesus monkeys anyway, doesn’t leave users with the stupids when they awake in the morning.

The three well-known sleeping pills: diazepam (Valium), zolpidem (Ambien) and eszopiclone (Lunesta), work by slowing down brain activity.

Orexins, which are also known as hypocretins, are brain chemicals that promote wakefulness. Of the brain’s billions of neurons, only tens of thousands produce orexins. People with narcolepsy who have difficulty staying awake and are prone to suddenly falling asleep without warning are missing almost all of the neurons that produce these chemicals. DORA-22 [the new, promising sleep medication] and similar drugs work by blocking orexins by essentially producing a brief and reversible bout of narcolepsy.

But…buyer beware.

“…because the orexin-blockers don’t seem to loop in the pleasure centers of the brain as the existing sleep medications do, they could also have a side effect of prompted bad moods, says Siegel, although that’s not such a problem if it only lasts a few minutes before you fall asleep.

Hmmmm.  Those of us with existing mood disorders need to keep tabs on this as the FDA continues its investigation.

Read more about DORA-22 and Orexins here.

Back From The Bin

“Check in with yourself and communicate when you think you’re starting to slide into a depression, mania or mixed state.”   I even preach that gospel on this blog. Sure, OK.

It would have been great if I’d taken the advice.

I spent a week cooling my jets in the hospital because I let things go a bit too far and entered a mixed episode.  Thankfully, a change in medication that was ordered the week before the hospitalization started to work while I was in The Bin. It shortened my stay and I am home now, and on the mend.

For those who aren’t familiar with mixed episodes, it’s where elements of both depression and mania are present at the same time.  The Vivien Brand of Mixed Episode inevitably involves depression with severe agitation.  That means instead of sitting in a corner crying, I am not sleeping, running around doing everything with a heavy hand, being overly agitated with the universe and everything in it  and crying.

Working through one of these mixed states is pretty hellish.  Depression meets adrenaline!  Filters be damned!  Everything is worthless and annoying! And nothing is sacred. Nothing.

I’ve agonized over how I should write about this experience. Do I satirize the whole ordeal, using my razor-sharp Mixed Episode Witt that had my husband and son laughing when they would visit me?  Do I describe the impatience and generally unkind Mixed Episode Agitated Thoughts I had toward my Club Mental Health cohorts?  Do I tally and publish the number of times I sat in my room and cried ’cause there’s no putting the brakes on Mixed Tears?

Well, no.  That’s the point  These damn mixed episodes are just so jam-packed full of emotion and mayhem that I really can’t compose a meaningful post within my self-imposed 1000-1200 word limit.

American Hotel, Amsterdam (Oh, the irony!)

But, I must say this.  For those keeping score, you will no doubt have noticed the hospitalization this past week took place in The Netherlands while my previous stay in 2010 took place in the US.  Both facilities were dedicated mental health hospitals for the not-so-insane.  The experience here in NL, however, was a night and day difference from what I experienced in the US.  Here, I wasn’t locked on a ward, I was given my own room and my shoelaces weren’t taken from me.  It was more along the lines of a hotel for crazy-ish people.  At no point did I feel my dignity was compromised or I wasn’t being respected as a person.  Maybe it was just the crap hospital I was admitted to in Kirkland, WA (Google away…) that handles their clientele inappropriately, but it’s been my overall experience mental health here is handled with much more dignity and grace and less stigma than I experienced across the pond.  So, in my next edition of ‘Round the World for the Mentally Ill, I will have to give The Netherlands accommodations more stars than those in The States.

I suppose when you are Bipolar I and didn’t treat the entire spectrum of the illness for over 20 years, extended periods of extreme stress are bound to put you in the hospital, if you don’t ask for help when it all starts to go bad.  OK, fine.  Lesson learned.

Mixed episodes, how I do not love thee.